


Madness and Civilization

by Sath



Category: Les Misérables - Victor Hugo
Genre: Canon Era, Enjolras continues to be unimpressed by Hugo's descriptions of him, Gen, Illustrated, Medicine, Mental Institutions, Misogyny, Period-Typical Racism, Pseudoscience, craniometers as metaphors, long Hugolian blocks of dialogue, phrenology, someone please give Joly the balloon ride he's always wanted
Language: English
Status: Completed
Published: 2013-10-28
Updated: 2013-10-28
Packaged: 2017-12-30 17:00:38
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 3,092
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/1021172
Author URL: https://archiveofourown.org/users/Sath/pseuds/Sath
Summary: <blockquote class="userstuff">
              <p>Disturbed by the violence of surgery, Combeferre asks to intern under Félix Voisin at an asylum during the spring of 1830. The fledgling science of psychology forces Combeferre to a difficult reconciliation between his personal values and the prejudices of his time.</p>
            </blockquote>





	Madness and Civilization

**Author's Note:**

  * For [AnguaLupin](https://archiveofourown.org/users/AnguaLupin/gifts).



The first time Combeferre observed a surgery, he held a little boy’s hand as he died. The child couldn’t have been more than eight, his leg taken with gangrene from an accident working at a tannery. He was brought in trembling, his wide green eyes senseless until the doctor began to cut. He’d screamed, and died. The doctor pronounced him dead, then invited Combeferre and the other students to lunch.

The second time, the patient survived. Combeferre found himself already less disturbed by the sound of the saw, the profusion of blood, the agony.

He requested to be transferred out of surgical rotation at the Hôtel-Dieu. Combeferre wrote two letters: the first was an apology to his mother for disappointing her, and the second was to Dr. Félix Voisin, the director of the Hospice des Incurables on the Rue des Sévres. When Voisin responded warmly and asked Combeferre to come see him at the hospital, he took the unsent letter to his mother and burned it.

~

The Hospice des Incurables was home to congenital idiots and the completely mad, all of them women. As a consequence, it drew huge crowds for lectures. The men had their own hospital on the Rue des Recollets, where they were forgotten by students and doctors alike. Voisin presented the hospital to Combeferre like a showman, drawing him through room after room with pronouncements of the ultimate fate of every patient. The women had not seemed so different to Combeferre, their principle variation only in whether they were fearful, violent, or simply senseless. But Combeferre was determined to be willfully credulous to anyone who would ward him both from the bloody table and the dismal parlors of the fashionably ill. The alienist who attended to the mentally ill left his patients whole, even when he failed. Progress must be made without inflicting suffering.

Combeferre’s first three days at the hospital had been relatively uneventful. He’d been attacked twice, someone threw a full chamber pot at him, and he’d been propositioned more times than he could count. Combeferre suspected the latter were done more out of boredom than anything else; the only entertainment the women were allowed, lest they become overexcited, was being exhibited to students. The best-behaved residents were rewarded with getting to work in the laundry room, which did the linens for most of the hospitals in Paris.

He did not get to watch one of Voisin’s lectures until his fourth day. Combeferre arrived late and had to stand in the very back of the room, pressed in by his peers and hardly able to see the patient Voisin was examining. She was middle-aged, her long hair let out of the hospital-regulation mob cap, and she sat on a stool with her hands clasped in her lap. Voisin introduced her as Mlle B—, prostitute. Mlle B— stared out at the men assembled in the quickly warming room, her eyes betraying no humiliation or interest.

“Today, messieurs, I will introduce you to an incontrovertible demonstration of the work of Drs. Gall and Spurzheim. Those outside of our profession like to scoff at the field of phrenology because they have no knowledge of the structure of the brain and how its organs may be measured. We are not scholars of lumps, or palmists who have confused the hands for the head.”

The doctor paused to let the students laugh.

“Henri de Mondeville wrote in the fourteenth century that ‘a surgeon must be able to cut like an executioner, politely lie and be clever. The sick above all want to be cured; the surgeon to be paid.’ Surgery is but the profitable application of suffering, and anyone who truly wants to practice medicine will avoid the discipline. Surgeons are necessary butchers, but advancement is not to made in the chop shop. I have come to believe that the nineteenth century will be the Age of the Mind. Medicine will start at the head, where curation is the most effective, and move downwards.”

Voisin made some theatrical passes over Mlle B—’s head with his hands. He took a firm hold of her skull and turned it to the side to measure the angle of her profile, then made some quick notations on his chart. Mlle B— held her pose.

“Heredity is the engine of mental illness. There is more proof of innate traits in the lunatic than the criminal, though they are often one and the same. This woman was admitted to the hospital in hysterics. She had been a prostitute for most of her life, starting from the age of twelve until she was brought here, aged forty-one. As you can see, she is unusually healthy for one of her class – see, messieurs, how she even has most of her teeth.” Voisin made her face the students again and briefly peeled back her lips from her gums. “Her eyes are clear. One could confuse her for a woman of thirty. However, she is completely unfit for society. My colleague, Dr. Falret, diagnosed her with circular insanity. She experiences the most extreme ecstasies of the sublime for days, without needing sleep nor rest, and becomes sexually voracious. No doubt, this woman was a prostitute by choice. When her fit of passion ends, she is overcome with such unresponsive melancholy that she can hardly be distinguished from the idiots of our hospital. After going through much effort to gain her trust, I discovered that both her mother  _and_  daughter are prostitutes as well. Allow me, messieurs, to demonstrate that this family legacy comes not from the ills of our modern society, but is rather, innate.”

The whole room tried to lean closer as one, and Combeferre was pressed against a particularly unpleasant student from Gascony. Combeferre wasn’t a short man, but he still had to go up on his toes to watch Voisin take out the craniometer. The device, which resembled a pair of giant calipers, dwarfed Mlle B—’s head as he positioned it over her, adjusting the movable rods until the ivory balls went inside her ear and fixed the craniometer in place. Its purpose was to measure the various protuberances and depressions of her skull.

“Make sure that the rods are at equal depths in the ears, otherwise the center axis of the craniometer will not be properly aligned with the  _medulla oblongata_. Don’t worry, you won’t damage the canals.” Voisin said this more quietly, already concentrating more on the patient than the students as he moved the index along her skull.

“You will find that the largest organs in this woman are Amativeness, Combativeness, and Secretiveness. While there is nothing inherently troubling about any of these functions individually - La Fontaine, for instance, had a highly developed Secretiveness - they can only lead to depravity when combined in this manner. Her Amativeness has led to unrestrained lust, and her Secretiveness only further encouraged her descent into harlotry. This woman’s misfortunes have only been exacerbated by her underdeveloped organs of Acquisitiveness and Conscientiousness. She has whored herself not for desire of money, but because she could not discern that what she did was wrong. Still more destructive is her truly shrunken organ of Philoprogenitiveness, cutting her off from a woman’s natural propensity towards a mother’s love. The extremities of her mental disorder are due to the hyperdevelopment of organs which would normally lead to greatness in a man of healthy disposition. Her organ of Ideality is the largest I have ever identified, and it is this which deranges her. She raves and rhymes, stricken by a sensitive perception of the world that has no proper outlet. Messieurs, do you think this woman deserves to be scorned? Should she be held in contempt for her heredity? This is about your mother, your sisters, children! Even this woman was pure once.”

The doctor fell silent. Mlle B—’s hair had become disheveled by the index, like she had just gotten out of bed. Voisin removed the craniometer, smoothing out her hair as he began to speak again.

“We as doctors have a responsibility to the alleviation of suffering. Everyone, regardless of birth or station, deserves care. Phrenology, if properly utilized, is a tool for promoting understanding. No one is innately evil - there are only natural propensities which can be managed, perhaps even, one day, cured.”

Voisin laid his hand on Mlle B—’s shoulder and thanked her for her cooperation.

“It was nothing,” she replied.

The students knew it was their cue to applaud, and the noise was like the clattering of carriage wheels. There were too many people in the room. Mlle B— had gotten up but was still hemmed in by students rushing in to deliver their congratulations and questions to Voisin. She could not push them out of the way, nor would they make space for her.

Combeferre elbowed the Gascon to the side, muttering an apology he hoped the student wouldn’t hear, and cut towards the woman.

“Pardon me,” Combeferre said, offering her his arm, “would you like me to help you back to your rooms?”

“The doctor said he would give me some tobacco for coming out.”

“I will remind him later.”

Mlle B— looked back at the throng before leveling her gaze on Combeferre. She was almost as tall as he was, and her bearing was perfectly straight. No one on the street would have guessed she was mad.

Drs. Spurzheim and Gall had made many measurements of many skulls, all painstakingly recorded. They were men of science. There were trends, averages, consistent ranges. Some doctors had dismissed their findings, but even now much of the medical establishment was resistant even to the idea of treating mental illness as anything but willful derangement. Voisin was one of the few administrators campaigning against the Bourbon government’s defunding of asylums, fighting for his patients’ basic humanity.

Mlle B— slipped her arm in Combeferre’s. The students parted for him and Combeferre was finally free of the heat and noise of the lecture hall. She directed him to the eastern wing to a room she shared with five other women.

“Thank you,” she said, the words coming out heavily.

“You’re welcome.”

“The doctor never keeps his word,” she said. “Fuck his ideas.”

The other women laughed and ushered Combeferre out of the room with a flurry of apologies for their companion’s mouth, too eager to be sincere.

~

Combeferre had thought to hide himself in the library of the Salpêtrière, remembering that most of his friends were law students but forgetting that Joly occasionally still studied.

“My friend, you are not looking well. If you’ve acquired a chill, I’m certain I could diagnose something even more horrible than you’ve already given yourself. Or is it your reading that disagrees with you, and not our mortal nature after all?”

Joly was as carefully turned out as always, wearing a purple velvet coat just to read a treatise on astronomy. He slid into the chair next to Combeferre and leaned closer until he could make out what Combeferre was reading.

“Spurzheim?” Joly said, his lips curling in distaste. “Please tell me you make nothing of his mental fibers and his  _Observations on Madness_.”

“I find him difficult to read,” Combeferre replied. “I am still trying to understand his view of the brain.”

“I find it quite simple.” Joly ran his hands through his natural curls, styled into a fashionable silhouette, and gave them a coquettish flick. “As I am the descendent of West Indians, the esteemed doctor can tell me the exact measure of my head before I’ve even left it behind. My brain case is smaller than that of the European, my brow low and similar to that of the gorilla or orangutan, and my chin, what is called the mental eminence, is as weak as my capability for reason. The organ of Veneration is typically large in the Negro, which has made me a most  _respectful_  young man. Our Concentrativeness makes me very attached to places, such as the Corinthe, despite declining standards of food and service. And lest you doubt that my grandfather was a true Frenchman, I have the national Love of Approbativeness, and will believe anything that is complimentary of myself.”

Joly’s expression, normally so cheerful, was suddenly mistrustful. He was looking at the book in Combeferre’s hands as if it would poison him. It had already tried. Combeferre opened his mouth to apologize, somehow, but Joly waved his hand.

“We all have our bugbears,” Joly said, smiling politely. “For instance, I believe that the force of the earth’s magnetic fields can affect one’s health. Should you ever invite me to your home, I will rearrange your bed, because your vision could be corrected by following the ley lines.”

“Phrenology comes from measurement, not superstition, which is a fact I’m trying to reconcile with its faulty conclusions,” Combeferre replied.

Joly held up the craniometer Combeferre had been using to glumly measure one of the Salpêtrière’s extensive collection of skulls and fiddled with its index. “Are you telling me this doesn’t look like a dowsing rod?” He held it over his head, posing like a haloed angel in an Easter play. “Measurements are only as accurate as the measure, and men are notorious for falling out of calibration. Do what everyone else does, and find yourself a control group. Read Enjolras – you know him well enough, he’ll sit for you.”

“He’ll find the whole operation ridiculous.”

“Isn’t it? We live in a changeable age, Combeferre.” Joly handed back the craniometer and put his boots up on the table, lounging with admirable dedication. “Now, let us discuss Biot’s writing on the movements of astronomical bodies. I maintain that if we cannot make fire rain down upon Louis-Philippe, we must at least procure a balloon and some acid.”

~

“Make it quick,” Enjolras said. “There are better things to study than the shape of my head.”

“Scientific methods must always be tested,” Combeferre replied.

Enjolras crossed his arms. He was sitting with uncharacteristic defensiveness, his legs akimbo and his head tilted away from the craniometer. “Alienism seeks to reduce the soul of a man to numbers and predestination. It is Calvinism of the cranium.”

“Dr. Voisin insists that all the patients at the Hospice des Incurables be measured in this way. You are a perfect example of the Hellenic type, which he supposes the best.”

“Any doctor who does not suppose the people good is wrong,” Enjolras said.

Combeferre found himself smiling for the first time in days. “Absolutely. Now please hold still.”

Enjolras let out a sigh, but straightened his neck so Combeferre could fit the device. Combeferre tried to be gentle, though the index still scraped against Enjolras’s hair.

The intimacy of it was appalling.

“You have a very well-developed organ of Conscientiousness,” Combeferre said, concentrating on the top of the skull. “Combined with your Firmness, it gives you an unwavering sense of the right. There is every indicator of profound mental health. You have a fine sense of Hope and Ideality. Your eyes are deeply set, a sign of a large organ of Language. ”

The index shifted as Enjolras raised his eyebrows. “Cicero must have had such a dome.”

Remembering how Voisin had said that rough approximations could be made by hand alone, Combeferre pressed his fingers down and against the back of Enjolras’s head.

“You lack Philoprogenitiveness, familial love.” Combeferre moved further down to compare his chaste friend to what had been so prominent in the prostitute Mlle B—. “And the love of the flesh.”

There was too long of a silence after that.

“How good to have your preconceptions verified,” Enjolras said. “You have me perfectly, if I would flatter myself.”

Combeferre sat down heavily, holding his temple as if it would do his thoughts some good and leaving Enjolras to unscrew the craniometer from his head. “I am quite tired of this.”

“You found what you expected. If my physiognomy predicts a strong, virtuous mind, it is because I am what people find handsome, not because my brain has pushed up my forehead. It is said that ‘a great deal of brow in a face is like a great deal of horizon in a view.’ You can reconstruct the look of a society by studying its aphorisms.”

“Society is a wound.” Now that Combeferre had said it, he could not stop himself. “A doctor is presented with the bodies of the poor and the insane and sees only patients who will accept pain in their ignorance but give him little compensation for it. We no longer blame the wretched for their misery; it is heredity which lifts us up and holds them down.”

“If madness is hereditary,” Enjolras said, his voice strictly measured, “then you should have read it in my skull. My mother was a madwoman and a suicide.”

The persistence of madness in the families of the rich was the  _de facto_  argument for heredity. It was unthinkable that Enjolras’s bright mind could ever be degraded the same way Combeferre had seen at the Hospice.

“You must not have inherited her affliction,” Combeferre said.

“Time will tell,” Enjolras replied, a tenseness in his jaw betraying his own misgivings. He reached out to squeeze Combeferre’s arm. “Heritability speaks against the basic goodness of man. Knowledge should erase social boundaries, not reinforce them.”

Combeferre could not be dishonest, even to himself, when caught up in Enjolras’s piercing sincerity.

“I had hoped to heal by studying medicine, but I cannot cultivate the dispassion I need to do whatever work is required of me. All I have done has perpetuated suffering.”

“Then leave! Give yourself over to the cause. You cannot mend with one hand what you must strike with the other. We are coming to the time of the sword, and a divided heart must first conquer itself before it takes on the tyrant.”

Combeferre longed for certainty. It would give him back what had been taken by the dying boy on the operating table.

“And when the soldiers of the revolution have finished with its monsters, those that know only the sword will turn it upon themselves,” Combeferre said.

He thought of the progress of mankind, and of its indefinite perfectibility. History as a straight line away from barbarism, with science and the arts holding the torch. A world of light.

But how should progress be measured?

Combeferre looked at the discarded craniometer. It had found women hysterical, Joly savage, and Enjolras without fault.

“I’ll keep my divided heart, if only to keep you good.”

**Author's Note:**

> The wonderful and talented [Nisie](http://nisiedrawsstuff.tumblr.com) did a [phrenological Amis illustration](http://nisiedrawsstuff.tumblr.com/post/65622435829/joly-jehan-and-combeferre-conducting-an), which is utterly lovely and an even cooler situation than the one I came up with. 
> 
> General research disclaimer: I used George Combe's _Elements of Phrenology_ , published in 1845, as my primary source for all the phrenology in here. The title is a nod to Foucault.
> 
> 1\. Félix Voisin (1794-1872) was one of the foremost supporters of phrenology in France.
> 
> 2\. Aliénisme was what psychology was called in France until about the 1840s. 
> 
> 3\. Franz Gall (1758-1828) and Johann Spurzheim (1776-1832) were the founders of phrenology, although everyone conveniently forgets they had a falling out. Spurzheim moved to the U.S. and was responsible for bringing the 'science' stateside, although it was pure American convenience that led to its popularity. 
> 
> 4\. Henri de Mondeville's _Cyrurgia_ was published in 1312. 
> 
> 5\. Jean-Pierre Falret (1794-1870) was a supporter of early concepts of heredity, and was the first person to identify the symptoms of what is currently known as bipolar disorder. 
> 
> 6\. Spurzheim's _Observations on Madness_ was published in 1817. 
> 
> 7\. Jean-Baptiste Biot (1774-1862) was the foremost expert on magnetism at the time. Joly is reading his _Traité élémentaire d'astronomie physique_ , published in 1811. Biot first became known for documenting the L'Aigle meteorite, where he ascertained that outer space was indeed falling on the town of L'Aigle. It must be said that Biot also flew in a hot air balloon with Joseph Louis Gay-Lussac in 1804, ascending to a height of 23,000 feet. Joly thought Biot was the raddest dude and was really disappointed hot air balloons were not a barricade combat option. 
> 
> 8\. Early phrenologists studied Greek busts to decide which facial shape they thought was the most evolved. 
> 
> 9\. Enjolras modifies a quote of Robespierre's when he says, "Any doctor who does not suppose the people good is wrong." The original was, "Any institution which does not suppose the people good, and the magistrate corrupt, is evil." 
> 
> 10\. The idea of humanity as having "indefinite perfectibility" is Condorcet's.
> 
> 12\. Almost forgot to mention that Enjolras quotes Hugo when he says, "a great deal of brow in a face is like a great deal of horizon in a view." It's part of Hugo's opening description of Enjolras.


End file.
